5/18/2015 version KCTCS Kentucky Community and Technical College System Based on the 2008 curriculum

Transcription

1 KENTUCKY MEDICAID NURSE AIDE 5/18/2015 version KCTCS Kentucky Community and Technical College System Based on the 2008 curriculum The color of this cover is not an indicator of the version.

2 TABLE OF CONTENTS Title Page Introductions 3 Nurse Aide Website 3 Medicaid Nurse Aide Test Coordinators 3 4 OBRA 5 Competency Evaluation 5 6 Records 6 Task List for Nurse Aide 7 8 Tips for the Written Test 9 Sample Written Test Items 10 Tips for the Skills Test 11 Skills for Performance Test Applying Knee High Elastic Stockings 12 Assist with Dressing & Undressing (Hemi-technique) 13 Bed Bath Full Assisting with the Partial Bed Bath 16 Bed Making Occupied Bed Making Unoccupied/Closed Catheter Care 21 Clearing the Obstructed Airway The Conscious Adult 22 Denture Care 23 Donning and Doffing Personal Protective Equipment for Contact Prec. 24 Giving Nail Care 25 Giving Female Perineal Care 26 Giving Male Perineal Care 27 Giving the Bedpan 28 Helping the Person to Walk 29 Measure and Record Height and Weight 30 Measure and Record Pulse, Respiration, and Blood Pressure 31 Positioning and Alignment Fowler s 32 Positioning and Alignment Lateral/Side 33 Positioning and Alignment Supine 34 Providing Mouth Care The Unconscious Resident 35 Range of Motion Exercises Elbow 36 Range of Motion Exercises Wrist 37 Range of Motion Exercises Hip 38 Transferring a Resident to a Wheelchair 39 Wash Hands Aseptically 40 Test Administration Procedures Notification of Test Scores 43 Renewal of Registration 43 Nurse Aide State-Registered Card 43 KRS Prohibition Against Employing Certain Felons Study Guide Changes Version Updates

3 INTRODUCTION This handbook is designed to provide nurse aide test candidates and nurse aide educators with general information about Kentucky s Nurse Aide Testing Program (KNAT). Any questions relating to the information in this handbook may be addressed to your local Medicaid Nurse Aide Coordinator. The approved text for the nurse aide training program is Mosby s Textbook for Long-Term Care Assistants in its most recent edition. The competency evaluation is based on this text. Each nurse aide trainee shall acquire an individual copy of the Mosby s text and workbook and shall not be changed for any portion of the costs incurred in facility based training, including books. NURSE AIDE WEBSITE The nurse aide website is located at This website contains valuable information for nurse aide students, test candidates, instructors, and facilities. This web address may be freely distributed The website contains, but is not limited to, such information as: Nurse Aide Study Guide Updates from the Publisher to the Textbook Medicaid Services Manual Contact Information for the KNAT Regional Coordinators Content is updated on a regular basis. Nurse Aide trainers are mandated to provide each student a copy of the most current version of the study guide at no charge. The study guide becomes the property of the nurse aide student.. Test candidates may schedule their assessment at ANY testing location. Test candidates are not mandated to use any particular testing facility regardless of where they received their training. MEDICAID NURSE AIDE TEST COORDINATORS Elizabeth Durham West Kentucky Community & Technical College HWY 62 W Blandview Rd PO Box 7408 Paducah, KY (270) (270) FAX edurham0008@kctcs.edu Nancy Propes Madisonville Community College Health Campus 750 N. Laffoon Street Madisonville, KY (270) (270) FAX Npropes0001@kctcs.edu Stephanie Bennett Elizabethtown Comm. & Tech. College 620 College Street Road Elizabethtown, KY Admin. Assistant: Carla Allen (270) (270) FAX carlam.allen@kctcs.edu Carol Murch Henderson Community College 2660 South Green St. Henderson, KY (270) (270) carol.murch@kctcs.edu 3

4 MEDICAID NURSE AIDE TEST COORDINATORS (Continued) Janet Layman Owensboro Community & Technical College 4800 New Hartford Road Owensboro, KY (270) (270) FAX Pam Bulle Bowling Green Technical College Glasgow Campus 129 State Avenue Glasgow, KY (270) (270) FAX Elizabeth McGinnis Ashland Comm. & Tech College 1400 College Dr TDC Room 119 Ashland, KY (606) (606) FAX Sandra Goforth Big Sandy Comm. & Tech College Johnson Bldg Rm J159F One Bert T Combs Dr Prestonsburg, KY (606) (606) FAX Sgoforth0009@kctcs.edu Donna Combs Hazard Community & Tech College 101 Vo-Tech Drive Hazard, KY (606) ext (606) FAX donna.combs@kctcs.edu Jennifer Nolan Southeast Kentucky Community & Tech College Pineville Campus US HWY 25E Pineville, KY (606) jennifer.nolan@kctcs.edu Brenda Hickland Hopkinsville Community College 720 North Dr. Hopkinsville, KY (270) (270) Bhickland0001@kctcs.edu Jefferson Community & Tech College 109 E. Broadway Louisville, KY Lindsay Hobbs lhester0007@kctcs.edu Reva Herald Gateway Community & Technical College Edgewood Campus 790 Thomas Moore Parkway Edgewood, KY (859) (859) FAX Reva.herald@kctcs.edu Sally Parker Maysville Community & Technical College 1755 US Hwy. 68 Maysville, KY (606) sparker0004@kctcs.edu Francis Beaty Somerset Community College 808 Monticello St. Somerset, KY (606) (606) FAX frances.beaty@kctcs.edu Bluegrass Community & Tech. College District 164 Opportunity Way Lexington, KY (866) FAX Michelle Lewis michelle.lewis@kctcs.edu bll-nurseaidetesting@kctcs.edu The Bluegrass District covers Lexington, Danville, Lawrenceburg, and Winchester 4

5 MEDICAID NURSE AIDE TRAINING OBRA The nursing home reform provisions of the Omnibus Budget Reconciliation Act (OBRA) (42USC139 6 R) of 1987 established a requirement for a nurse aide training and competency evaluation program for nurse aides who are employed by nursing facilities. Cabinet for Health and Family Services, Department for Medicaid Services is the appointed regulatory authority. A nurse aide is defined as any individual including a nursing student, medication aide and one employed through a nursing pool, providing nursing or nursing related services to facility residents, who is not a licensed health professional or volunteer. There is a requirement for a registry of all individuals who have satisfactorily completed a nurse aide training and competency evaluation program, or a nurse aide competency evaluation. The registry shall be established and shall be maintained by the Kentucky Board of Nursing. In addition to the names of individuals having satisfactorily completed the nurse aide training and competency evaluation program, the registry shall include information addressing any State findings concerning any individual resident abuse or neglect or misappropriation of resident s property, and a brief statement (if any) by the aide disputing the findings. COMPETENCY EVALUATION The Kentucky Community and Technical College System (KCTCS) has responsibility for the final written or oral examination and the skills demonstration aspect of the competency evaluation. The test questions are developed based on the State-approved curriculum with input from members of the Nurse Aide Training Advisory Committee. The test is validated by KCTCS to ensure its reflection of the material presented in the training. KCTCS also has responsibility to maintain the integrity of the test and the individual examinations. The oral examination may be substituted for the written examination for persons with a documented limitation of literacy skills. The skills-demonstration aspect of the examination must consist of a minimum performance of five (5) skills. These five (5) skills are randomly selected from a pool of evaluation items. If a student has a disability, an alternate form of the test may be administered. The alternate form of the test must be requested by the nurse test candidate. This request must be submitted on the appropriate form obtained from your regional KNAT coordinator at least 2 weeks prior to the test date. LATEX ALLERGY: If a student has a latex allergy, non-latex gloves may be requested by the nurse aide test candidate. This request must be submitted to the KNAT coordinator at least 2 weeks prior to the test date. 5

6 MEDICAID NURSE AIDE TRAINING COMPETENCY EVALUATION (continued) To satisfactorily complete the evaluation, the student must: 1. Make a score of at least 70% (raw score of 52 or higher) on the 75 multiple-choice written examination; and 2. Must successfully demonstrate at least five (5) procedures under the observation of an examiner, with 70% accuracy. Some steps on some of the procedures are considered critical. These steps must be performed with 100% accuracy. An asterisk has denoted these steps. A test candidate, who fails either part of the examination, may reschedule to take the exam at the next available test date. If the test candidate fails the written test but passes the performance test, the candidate must repeat the written test only. If the test candidate fails the performance test but passes the written test, the test candidate is required to repeat the performance test including all 5 skills. An employed individual has only three (3) opportunities to pass the test within the initial four (4) month employment period. An individual not currently employed in longterm care has three (3) opportunities to successfully complete the competency evaluation and be placed on the registry within one year of completion of training. (This includes nursing students, also.) To apply for the competency evaluation program (CEP) a candidate must contact the health care facility administrator, who will then contact the Medicaid nurse aide test coordinator at the nearest test site. Nursing students and unemployed individuals with documentation of approved training (i.e. transcript of fundamentals, letter from training program which includes verification of clinical training component, etc.) may apply for the CEP by contacting a Medicaid nurse aide test coordinator listed on pages 4 5 of this study guide. Health Science students may apply for the CEP after successfully completing the Medicaid nurse aide curriculum in an approved training site. RECORDS Within thirty (30) days of satisfactory completion of the competency evaluation, KCTCS shall forward to the Kentucky Nurse Aide Registry, the name and social security number, address and test date of students who have successfully completed the competency evaluation. The student, the nursing facility administrator, the training instructor, and the test coordinator will be advised in writing by KCTCS, of the competency evaluation (test) results. The Kentucky Board of Nursing shall maintain, on the registry, the name of each student who has successfully completed the competency evaluation. Registry toll free Nurse Aides: Online verification: Registry (toll)

7 The Kentucky Medicaid Nurse Aide Test consists of seventy-five (75) written multiple-choice test items, which are taken from the following task list. TASK LIST FOR MEDICAID NURSE AIDE Task Chapter 1. Practice good personal hygiene 3 2. Maintain good personal health 3 3. Exhibit acceptable behavior 3 4. Work cooperatively with others 3 5. Maintain confidentiality 3 6. Observe the Resident s Rights 2 7. Identify and report abuse or neglect to appropriate person 2 8. Use plan of care to meet resident s needs 5 9. Communicate with resident, family, and staff 4,8 10. Assist resident in use of intercom/call system/telephone Report observations/information to appropriate personnel 5,6 12. Recognize health problems related to the aging process Recognize needs of the resident with cognitive impairment 39, Assist with providing recreational activities for the resident Assist with giving postmortem care Follow standard precautions & bloodborne pathogens standard Wash hands aseptically Provide for environmental safety Adjust bed and side rails Assist with application of protective devices Report unsafe conditions to appropriate person Assist with care of resident with oxygen Follow fire and disaster plan Assist resident who has fallen Assist resident who has fainted Assist resident who is having a seizure Clear the obstructed airway - the conscious adult Using elevation, direct pressure, and pressure points to control bleeding Serve meals and collect trays Recognize diet modifications/restrictions Check food tray against diet list Feed or assist resident in eating Administer after meal care Record and report intake and output Give bed bath Assisting with the partial bath Assist resident with tub bath Assist resident with shower Make unoccupied (closed) bed Make occupied bed Perform or assist in performing oral hygiene for the conscious/unconscious resident Assist with or shave resident Give backrub Give perineal care Shampoo/groom hair Give nail care Assist resident with dressing and undressing Provide urinary catheter care 21 7

8 TASK LIST FOR MEDICAID NURSE AIDE (Continued) Task Chapter 49. Provide care for the urinary incontinent resident Provide care for the bowel incontinent resident Assist resident in bladder retraining Assist resident in bowel retraining Assist resident in using bedpan/urinal Assist with enema administration Collect routine/clean catch urine specimen Collect stool specimen Collect sputum specimen Use good body mechanics Perform or assist with range of motion exercises Turn and position the resident in bed Transfer resident to and from bed/chair Use a mechanical lift to transfer resident Apply and use gait belt Assist resident with standing/walking Assist resident in using cane/walker Transport resident by wheelchair Move resident between stretcher and bed Assist with admission, in-house transfer, and discharge of resident Measure and record resident temperature by using oral, auxiliary, rectal and tympanic routes using non-mercury glass/electronic thermometer Measure and record radial pulse Measure and record respiration Measure and record blood pressure Measure and record resident height/weight Assist in prevention of pressure/circulatory ulcers Apply elastic stockings Donning and Doffing Personal Protective Equipment 13 8

9 TIPS FOR THE WRITTEN TEST There are a number of skills that may help you improve your ability to take a test. Here are some tips that are strongly recommended: Get a good night s rest before the test. Be familiar with the test directions. If anything in the directions is not clear, ask the test administrator to clarify. You will have a few minutes to ask questions before the test begins. Think through each question. Read each question word for word. Consider all of the answer choices. Do not choose the first answer that seems reasonable. Read and evaluate all choices to find the best answer to the question. Give careful consideration before going on to the next question, but do not spend too much time on any one question. When selecting the best answer to a question, do not re ad too much into the questions. The questions are written to be clear and straightforward. They are not intended to be tricky or misleading. If, after considering all answer choices, the correct answer is not clear, eliminate the choices you know are incorrect and choose from the remaining answers. You may want to review the questions after you have completed the rest of the test. Always guess even if you cannot eliminate any of the possible responses. Every question will be scored right or wrong. Your test score is based on the number of questions answered correctly. You do not lose points for incorrect answers, so you will not be penalized for guessing. After you have finished the test, review your answers. If possible, check all responses. Do not be afraid to change your answer. However, before changing your answer, consider the reason for your original answer. Check all answers to be sure that they are correctly recorded on the answer sheet. Be sure that your answers are recorded next to the number on the answer sheet corresponding to the question number. Facilities and test candidates are encouraged to schedule the test so they do not work 12 hours prior to the competency evaluation. 9

10 SAMPLE WRITTEN TEST ITEMS Test Item: 1. A specimen collected by having the resident cough up a substance from the lungs and bronchial tubes is called A. saliva B. mucus C. sputum D. spit 2. You see bruises on a resident s face. You should notify A. a state agency responsible for abuse B. the charge nurse C. the family D. the physician Bubble in the response for the sample written test items above 1. A B C D E 2. A B C D E Correct Answers: 1. C 2. B 10

11 TIPS FOR THE SKILLS TEST The skills demonstration aspect of the examination must consist of a minimum performance of 5 randomly selected skills The following skills will be used for test purposes. At least 70% of the steps must be performed correctly in each skill. Some of the steps within a skill are considered critical and must be performed at 100% accuracy. An asterisk (*) identifies the critical steps. A critical step is defined as a step within a task that relates to physical safety of the resident or nurse aide or medical asepsis (infection control). Sequencing of steps will not be considered critical unless it becomes a physical safety or medical asepsis violation as defined above. The skills test is not designed to teach. The skills test is designed to measure competency. No help will be given. All test candidates are expected to complete the skills in a timely manner. At the evaluator s discretion, you may be given a 5 minute warning to finish the current skill. For clarification of procedures, test candidates are encouraged to refer to the procedure checklist in your workbook. Promoting Safety and Comfort: Bed Rails - page 156 of the approved text Safety You raise the bed to give care. Follow these safety measures to prevent the person from falling: For a person who uses bed rails Always raise the far bed rail if you are working alone. Raise both bed rails if you need to leave the bedside for any reason. For the person who does not use bed rails Ask a co-worker to help you. The co-worker stands on the far side of the bed. This protects the person from falling. Never leave the person alone when the bed is raised. Always lower the bed to its lowest position when you are finished giving care. Comfort The person has to reach over raised bed rails to access items on the bedside stand and overbed table. Such items include the water pitcher and cup, tissues, phone, and TV and light controls. Adjust the overbed table so it is within the person s reach. Ask if the person wants other items nearby. Place them on the overbed table too. Always make sure needed items, including the signal light, are within the person s reach. For the purpose of testing, the resident s care plan indicates side rails are not to be used. Side rails will be raised when the bed is raised. Side rails will be lowered when the bed is lowered. 42 C.F.R (a) provides that the resident has the right to be free from any physical or chemical restraints imposed for discipline or convenience, and not required to treat the resident s medical symptom. Centers for Medicare & Medicaid Services (CMS) defines physical restraints in the State Operations Manual (SOM), Appendix PP as, any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident s body that the individual cannot remove easily which restricts movement or normal access to one s body. You will be expected to perform the skills as you would in a nursing home setting. When water is required, water should be used. All candidates will be required to perform the Wash Hands Aseptically skill. The evaluator will inform you after you have washed your hands for the first time that you should tell him or her when you would wash your hands during your performance of the rest of the skills rather than actually washing them for each skill. No other steps will give you credit for simply verbalizing to the evaluator what you would do, or for simulating the step, unless noted in this study guide next to that particular step within a skill. To receive credit for all other steps, you must actually demonstrate the step. The test will consist of 5 of the 26 skills, which follow: 11

12 APPLYING KNEE HIGH ELASTIC STOCKINGS 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise bed rails. Raise bed to best level for good body mechanics. 3. Lower side rail on the side you are working. Place in supine position. 4. Expose the leg while providing for privacy 5. Turn the stocking inside out down to the heel. 6. Slip the foot of the stocking over the toes, foot, and heel. 7. Grasp the stocking top. Slip it over the foot and heel. Pull it up the leg. The stocking turns right side out as it is pulled up. The stocking is even and snug. 8. Remove twists, creases, or wrinkles. *9. Raise the side rail. 10. Go to the other side and lower the side rail. 11. Repeat steps 5 through 8 for the other leg (May verbalize this step) *12. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 13. Wash hands and report & record observations. 12

13 ASSIST WITH DRESSING AND UNDRESSING (Hemi-technique) Dependent Resident 1 Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise bed rails. Raise bed to best level for good body mechanics. 3. Lower side rail on resident s weak side. Place in supine position. 4. Cover resident with bath blanket. Fanfold linens to foot of bed without exposing resident. 5. Raise resident s head and shoulders or turn onto side away from nurse aide. 6. Unfasten buttons, snaps, zippers, or ties in back of garment. 7. Bring sides of garment to the resident s sides, or if in side-lying position, tuck far side under resident and fold near side onto chest 8. Place resident in supine position. 9. Slide garment off shoulder on resident s strong side. Remove garment from the arm. Repeat for weak side. 10. Put on garments that open in the front: slide garment onto arm and shoulder of weak side. 11. Raise head and shoulders. Bring side of garment around the back. Lower resident to supine position. 12. Slide garment onto the arm and shoulder of the strong arm. 13. Fasten buttons, snaps, zippers, or ties. 14. Put on pants or slacks. Slide pants over feet and up the legs. 15. Turn onto the strong side and pull pants over buttocks and hip of weak side. 16. Turn resident to the weak side and pull pants over buttocks and hip of strong side. 17. Place resident in supine position and fasten buttons, snaps, zippers, ties, and/or belt buckle. 18. Remove bath blanket. 19. Put socks and shoes or slippers on resident. *20. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 21. Wash hands and report & record observations. 13

14 BED BATH - FULL 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. 2. Fill bath basin 2/3 full of warm water. *3. Raise bed rails. Raise the bed to best level for good body mechanics. 4. Lower bed rail and position resident in supine position. 5. Cover the resident with a bath blanket and remove top linens. 6. Lower bed rail and place towel across resident s chest. 7. Make mitten of washcloth and wet with water; squeeze out excess. 8. Wash eyes first. Start at inner corner and work out. Use different area of mitten for each eye. 9. Wash, rinse, and dry the face. 10. Wash, rinse, and dry the ears and then neck. 11. Remove the gown without exposing the resident. 12. Expose arm farthest from the side. Place bath towel under arm up to axilla. 13. Place basin of water on bed and immerse resident s hand in water and wash. Remove the basin and dry hand well. 14. Wash and rinse shoulders, axillae and arms. 15. Repeat steps 12, 13, & 14, using nearest arm. (May Verbalize This Step) 16. Place towel across chest and fold bath blanket to waist. 17. Wash, rinse, and dry chest while lifting towel. 18. Dry the skin thoroughly. 19. Fold bath blanket to pubic area; keep chest covered with towel. 20. Wash, rinse and dry abdomen. Remove the towel and cover with bath blanket. *21. Raise the side rail before leaving the bedside. Change bath water in basin. 22. Lower bed rail. See Next Page 14

15 23. Expose the far leg; flex leg and place bath towel lengthwise under the leg up to the buttocks. 24. Place basin on towel and put foot into it. Support leg at knee joint with hand. 25. Wash and rinse leg and foot. 26. Remove basin of water and dry leg, foot, and between toes. 27. Repeat steps #23 - #26 for near leg. (May verbalize this step) *28. Raise the side rail before leaving the bedside. Change bath water in basin. 29. Lower bed rail and assist resident to turn on side with back facing the aide. 30. Fold the bath blanket over resident s side to expose back and buttocks; place towel parallel to resident s back. 31. Wash, rinse and dry back and buttocks. 32. Give back rub and remove towel and turn resident onto back; place towel under buttocks. *33. Raise the bedrail before leaving the bedside. Change the water for perineal care. 34. Lower bed rail. *35. Put on disposable gloves. 36. Wash, rinse, and dry the perineum. (may verbalize, perineal care tested on separate skill) Remove towel under buttocks. *37. Remove and discard gloves. Wash your hands. Raise the bedrail before leaving the bedside. 38. Apply lotion and deodorant. 39. Without exposing the resident, dress him/her in a clean gown. *40. Raise the bedrails. Lower bed. Lower bedrails. Attach signal light within resident s reach. 41. Wash hands and report & record observations. 15

16 ASSISTING WITH PARTIAL BED BATH 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. 2. Cover the resident with a bath blanket and remove top linens. 3. Fill the washbasin 2/3 full with warm water. 4. Place the basin on the over-bed table. 5. Raise the head of the bed so resident can bathe comfortably. 6. Help the resident remove the gown or pajamas. 7. Position the over-bed table so the resident can easily reach the basin and supplies. 8. Ask resident to wash easy-to-reach body parts. Explain that you will wash the back and those areas that cannot be reached. *9. Attach signal light within resident s reach. 10. Return to resident s room when signal light is on. Wash hands. (may verbalize) 11. Change the bath water. *12. Raise the side rails. Raise the bed to the best level for good body mechanics. Lower side rail nearest you. 13. Assist resident to wash areas that could not be reached. (may verbalize, including the use of gloves if needed.) 14. Apply deodorant and lotion. 15. Help resident put on clean clothes, a gown, or pajamas. *16. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 17. Empty, clean, and store the supplies appropriately. 18. Wash hands and report & record observations. 16

17 BED MAKING - OCCUPIED 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise bed rails. Raise bed to best level for good body mechanics. 3. Lower side rail nearest you. 4. Wear gloves if linens are soiled. (may verbalize) 5. Loosen the top bedding at foot of bed. Remove spread and/or blanket. 6. Place bath blanket over top sheet. Remove top sheet without exposing resident. 7. Keep pillow under resident s head and turn resident to side of bed not being made. 8. Loosen bottom bedding; free bottom linen and roll each piece separately to the resident s back. 9. Place bottom sheet lengthwise with fold in center and lower edge of sheet even with foot of mattress. Face hem stitching downward. 10. Tuck sheet under head of mattress; miter corners; tuck well under side of mattress. 11. Fanfold surplus sheet close to resident s back. 12. Place draw sheet on middle 1/3 of mattress; fanfold 1/2 to resident s back and tuck in excess material. *13. Raise side rail of bed. 14. Go to opposite side of bed; lower bedside rail. 15. Move resident to clean side of bed and then place pillow under resident s head. 16. Pull through all bottom linen. Roll, remove, and discard soiled linen in laundry hamper or bag. Hold soiled linen away from own uniform. 17. Pull clean bottom sheet toward the edge of bed. Tuck it under the mattress at the head of the bed and make a mitered corner, tuck it well under the side of the mattress. 18. Pull the sheet toward foot of bed and remove all wrinkles. Pull the draw sheet; tighten, and tuck excess under the mattress. 19. Assist resident to center of bed. 20. Place top sheet over bath blanket; ask resident to hold or tuck under resident s shoulders. Remove bath blanket. Replace blanket/spread. 21. Tuck sheet, blanket, and bedspread at foot of bed under mattress and miter corners on each side, allowing for movement of resident's feet. See Next Page 17

18 22. Change pillowcase and place pillow under resident s head *23. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 24. Recess bed cranks (if necessary). 25. Wash hands and report & record observations. 18

19 BED MAKING UNOCCUPIED / CLOSED 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise bed to best level for good body mechanics. 3. Remove linens from bed, rolling linen away from you so that the surface that touched the resident is inside the roll. 4. Place the bottom sheet on the mattress. Unfold it lengthwise. Place the center crease in the middle of the bed. Position the lower edge evenly with the bottom of the mattress. Face hem stitching downward 5. Pick the sheet up from the side to open it. Fanfold it toward the other side of the bed. 6. Go to the head of the bed. Tuck the top of the sheet under the mattress. Make sure the sheet is tight and smooth. Make a mitered corner. 7. Place the draw sheet on the middle 1/3 of the mattress. 8. Open the draw sheet and fanfold to the other side of the bed. 9. Tuck draw sheet and go to other side of the bed. 10. Miter the top corner of the bottom sheet. 11. Pull the bottom sheet tightly to smooth out wrinkles. Tuck well under side of mattress. 12. Pull the draw sheet tightly and tuck in the sheet. 13. Go to other side of bed. 14. Place the top sheet on the bed. Unfold it lengthwise. Place the center crease in the middle. Place the sheet evenly with the top of the mattress. Open the sheet and fanfold the extra toward the other side. Face hem stitching outward. 15. Place the bedspread on the bed with the upper hem even with the top of the mattress. Open and fanfold extra to the other side. 16. Make sure the bedspread facing the door is even and covers all the top linens. See Next Page 19

20 17. Tuck in the linens together at the foot of the bed. Make a mitered corner. 18. Go to other side of bed. Straighten all top linen, tucking in top linens. Make a mitered corner. 29. Put pillowcase on pillow and place on bed with open end away from the door. *20. Lower bed. Attach signal light within resident s reach. 21. Wash hands and report & record observations. 20

21 CATHETER CARE 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise side rails. Raise bed to the best level for good body mechanics. 3. Lower side rail nearest you, place resident in supine position, and drape resident. Fanfold linens to foot of bed. *4. Put on disposable gloves. 5. Place bed protector on bed under buttocks. 6. Expose perineal area. 7. Separate the labia of the female or retract the foreskin (uncircumcised male) and check for any crusts, abnormal drainage, or secretions. *8. Gently wash around the opening of the urethra with soap and water. *9. Holding the catheter near the meatus, clean the catheter from the meatus down the catheter about 4 inches, using soap, water and a clean washcloth. Clean downward away from the meatus with one stroke. Repeat as needed with a clean area on the washcloth each time. Rinse and pat dry. 10. Secure catheter properly. Coil and secure tubing to the bed. 11. Remove the bed protector. 12. Remove and discard the gloves. 13. Cover resident and remove bath blanket. 14. Make sure the resident is comfortable. *15. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 16. Wash hands and report & record observations. 21

22 CLEARING THE OBSTRUCTED AIRWAY - THE CONSCIOUS ADULT 1. Ask the victim if they are choking. *2. Determine if the victim can cough or speak. *3. Stand behind the victim. *4. Wrap your arms around the victim s waist. *5. Make a fist with one hand. Place the thumb side of the fist against the abdomen. The fist is in the middle above the navel and below the end of the sternum. *6. Grasp your fist with your other hand. *7. Press your fist and hand into the victim s abdomen with a quick, upward thrust. *8. Repeat the abdominal thrust until the object has been expelled or the victim loses consciousness. 22

23 DENTURE CARE 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. 2. Raise the head of the bed. Position the resident for resident for oral hygiene. Place towel over the resident s chest. *3. Put on disposable gloves. 4. Ask the resident to remove dentures or remove resident s dentures using gauze if the resident cannot do so. 5. Grasp the upper denture with the thumb and index finger of one hand. Move the denture up and down slightly to break the seal. Gently remove the denture and place in kidney/emesis basin or denture cup. 6. Remove the lower denture by grasping it with your thumb and index finger. Turn it slightly, and lift it out of the mouth. Place the denture in kidney/emesis basin or denture cup. 7. Line the sink with a towel and fill with water. 8. Take dentures and equipment to the sink and rinse each denture under warm running water. Return to denture cup. *9. Apply denture cleaner or toothpaste to the brush and brush and rinse dentures. Place in denture cup. Fill it with cool water. 10. Clean kidney/emesis basin. Bring basin and denture cup to bedside. 11. Position the resident for oral hygiene. 12. Ask the resident to rinse his/her mouth with mouthwash. Hold the kidney/emesis basin under the resident s chin. 13. Ask resident to insert dentures. Insert the dentures if the resident cannot. 14. Grasp the upper denture with thumb and index finger. Raise the upper lip with the other hand and insert denture. Use index fingers to press gently on upper denture to make sure that it is secure. 15. Grasp the lower denture securely with thumb and index finger. Pull down slightly on the lower lip and insert the denture. 16. Put denture cup in the top drawer of the bedside stand. *17. Remove and discard gloves. *18. Attach signal light within resident s reach. 19. Wash hands and report & record observations. 23

24 DONNING AND DOFFING PERSONAL PROTECTIVE EQUIPMENT FOR CONTACT ISOLATION 1. Remove your watch and all jewelry. Roll up uniform sleeves. 2. Wash hands aseptically. (May verbalize) 3. Hold a clean gown out in front of the body. Let it unfold. Do not shake the gown. 4. Put hands and arms through the sleeves. Make sure the gown covers from the neck to the knees. It must cover the arms to the end of the wrists. Tie the strings at the back of the neck. *5. Overlap the back of the gown covering the back of the uniform snugly. (If the gown does not cover the back, the use of a second gown may be verbalized to ensure protection.) 6. Tie the waist strings. Tie them at the back or the side. Do not tie them in front. *7. Put on disposable gloves with gloves extended to cover the gown cuffs. Provide care. *8. Remove gloves grasp a glove just below the cuff. Grasp it on the outside. Pull the glove down over your hand so it is inside out. 9. Hold the removed glove with your other gloved hand. *10. Reach inside the other glove. Use the first two fingers of the ungloved hand. 11. Pull the glove down (inside out) over your hand and the other glove. 12. Discard the gloves. 13. Untie the neck and waist strings. Pull the gown down from each shoulder toward the same hand. *14. Turn the gown inside out as it is removed. Hold the gown at the inside shoulder seams and bring your hands together. *15. Hold and roll up the gown away from you. Keep inside out. 16. Discard the gown. 17. Wash hands aseptically. (May verbalize) 24

25 GIVING NAIL CARE 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. 2. Position the over bed table in front of the seated resident. It should be low and close to the resident. 3. Fill the kidney basin with warm water. 4. Place the kidney basin on the over bed table on top of the paper towels. 5. Put the resident s fingers into the basin. Position the arms so that he or she is comfortable. 6. Let the fingernails soak for 5 to 10 minutes (may verbalize without waiting). Re-warm the water as needed. 7. Clean under the fingernails with the orange stick. 8. Remove the kidney basin. Dry fingers thoroughly. 9. Clip fingernails straight across with nail clippers. 10. Shape nails with an emery board or nail file. 11. Push cuticles back with a washcloth or orange stick. 12. Clean and return equipment and supplies to their proper places. Discard disposable supplies. *13. Attach signal light within resident s reach. 14. Wash hands and report & record observations. 25

26 GIVING FEMALE PERINEAL CARE 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. 2. Fill the wash basin with warm water. *3. Raise side rails. Raise bed to the best level for good body mechanics. 4. Lower side rail nearest you. Position the resident on her back, drape with a bath blanket and remove top linen. *5. Put on disposable gloves. 6. Place a waterproof pad under buttocks. 7. Assist the resident to flex knees and spread legs, if able. Otherwise, help the resident to spread legs as much as possible with knees straight. 8. Apply soap to a washcloth. *9. Separate the labia. Clean downward from front to back with one stroke. 10. Repeat steps 8 & 9 until the area is clean. Use a clean part of the washcloth for each stroke. Use more than one washcloth if needed. *11. Rinse the perineum with a clean washcloth. Separate the labia. Stroke downward from front to back. 12. Pat the area dry with the towel. 13. Assist the resident to lower the legs and turn onto the side, away from you. *14. Wash from the vagina to the anus with one stroke. Rinse and pat dry. 15. Remove waterproof pad. *16. Remove and discard the gloves. 17. Cover the resident with top linen and remove the bath blanket. *18. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 19. Wash hands and report & record observations. 26

27 GIVING MALE PERINEAL CARE 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. 2. Fill the wash basin with warm water. *3. Raise side rails. Raise bed to the best level for good body mechanics. 4. Lower the side rail nearest you. Position the resident on his back, drape with a bath blanket and remove top linen. *5. Put on disposable gloves. 6. Place a waterproof pad under buttocks. 7. Apply soap to a washcloth. 8. Grasp the penis. Retract the foreskin if the person is uncircumcised. 9. Clean the tip. Use a circular motion. Start at the urethra, and work outward. Repeat as needed. Use a clean part of the washcloth each time. 10. Rinse the area with another washcloth. 11. Return the foreskin to its natural position. 12. Clean the shaft of the penis. Use firm downward strokes away from the urinary meatus. Rinse the area. 13. Help the person flex his knees and spread his legs. Or help him spread his legs as much as possible with knees straight. 14. Clean the scrotum. Rinse well. Observe for redness and irritation in the skin folds. 15. Pat the penis and scrotum dry. 16. Help him lower his legs, cover him, and turn him onto his side away from you. Fold the bath blanket back between his legs. 17. Wash, rinse, and pat dry the anal area. Wash from the scrotum to the anus with 1 stroke. 18. Remove the waterproof pad. *19. Remove and discard gloves. 20. Cover the resident with top linen and remove bath blanket. *21. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 22. Wash hands and report and record observations. 27

28 GIVING THE BEDPAN 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise side rails. Raise bed to the best level for good body mechanics. 3. Lower the side rail nearest you. Position the resident in supine position. *4. Put on disposable gloves. 5. Turn the resident onto his/her side away from you and correctly place the bedpan firmly against the buttocks. 6. Push the bedpan down and toward the resident. 7. Hold the bedpan securely. Turn the resident onto his/her back. Center the bedpan under the resident. Remove gloves. 8. Raise the head of the bed so the resident is in a sitting position. *9. Place the signal light within resident s reach. Raise side rail. Lower bed. Lower side rail. 10. Place the toilet tissue within reach of the resident. Ask the resident to signal when through or when assistance is needed. 11. Wash your hands. Leave the room and close door. (may verbalize) 12. Return when the resident signals. (may verbalize) *13. Wash hands. Put on disposable gloves. *14. Raise side rails. Raise the bed to the best level for good body mechanics. Lower the side rail nearest you and head of the bed. 15. Remove the bedpan. You need to hold the bedpan securely and turn him or her onto the side away from you. *16. Clean the perineal area from front to back with toilet tissue. Provide perineal care if necessary. Cover the bedpan. Remove one glove and discard. *17. With ungloved hand, raise side rail. Lower the bed. Lower side rails. With gloved hand, take bedpan to the bathroom. Remove remaining glove. Wash hands. Put on disposable gloves. 18. Measure urine if the resident is on intake and output. Collect a urine specimen if needed. Empty, clean & rinse bedpan. (may verbalize). Remove gloves. Wash hands. 19. Put on disposable gloves (may verbalize), and store the bedpan. Remove and discard gloves. 20. Put on disposable gloves. Help the resident wash hands. Remove gloves. (may verbalize) 21. Wash your hands. (may verbalize). *22. Attach signal light within resident s reach. 23. Report & record observations. 28

29 HELPING THE PERSON TO WALK 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Adjust bed to lowest position and lock bed wheels. 3. Fanfold top linens to the foot of the bed. Put on shoes or non-skid footwear. 4. Raise the head of the bed up (Fowler s position), help the person to dangle. *5. Apply the transfer belt. 6. Help the person to stand. Grasp the transfer belt on each side. 7. Stand at the person s side while they gain balance. Hold the belt at the side and back. 8. Encourage the person to stand erect with the head up and back straight. 9. Help the person walk. Walk to the side and slightly behind the person. Provide support with the transfer belt. 10. Encourage the person to walk normally. The heel strikes the floor first. Discourage shuffling, sliding or walking on tiptoes. 11. Walk the required distance without rushing the person. 12. Help the person return to bed. Remove the transfer belt. 13. Lower the head of the bed. Help the person to the center of the bed. 14. Remove footwear and cover the resident. *15. Attach signal light within the resident s reach. 16. Wash hands and report & record observations 29

30 MEASURE AND RECORD HEIGHT AND WEIGHT 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. 2. Raise height-measuring rod and adjust scale to zero. 3. Place paper towel on the scale platform. 4. Ask resident to remove slippers/shoes (assist if necessary). 5. Assist resident onto scale. 6. Move the weights until the balance point is in the middle. *7. Read and record the weight within 1 lb. 8. Ask resident to stand erect. 9. Adjust height meter to top of head and note height. 10. Assist resident off platform and adjust weights to zero. 11. Assist resident in putting on slippers/shoes. Assist to his/her bed or chair. *12. Record the height within 1 inch. *13. Attach signal light to within the resident s reach. 14. Wash hands and report & record observations. 30

31 MEASURE AND RECORD PULSE, RESPIRATION AND BLOOD PRESSURE 1. Knock before entering the room. Identify and greet resident. Explain procedure to resident. Wash your hands. Provide privacy. 2. Position the resident seated/reclining. 3. Find the resident s radial pulse by placing your middle two or three fingers on palm side of resident s wrist on thumb side, next to bone. 4. Count for 30 seconds, times 2 if regular (count for 1 minute if irregular). 5. Continue to hold the resident s wrist and begin counting when you see the chest rise; count respiration for 30 seconds, times 2 if regular (count for 1 minute if irregular). *6. Recount respiration if unsure. Record respiration on paper. Recorded respiration must be within 5 of that obtained by the evaluator. *7. Record pulse. Recorded pulse must be within 5 pulse counts of that obtained by the evaluator. 8. With the resident seated/reclining with the entire lower arm on a flat surface. 9. Expose the arm as much as possible. Squeeze the cuff to expel any remaining air and turn the valve clockwise on the bulb to close it. 10. Wrap cuff snugly around the upper arm--at least one inch above the elbow. 11. Clean earpieces and diaphragm of the stethoscope with alcohol sponge. 12. Locate the brachial artery at the inner aspect of the elbow. 13. Place the earpieces of the stethoscope in your ears. 14. Place the diaphragm of the stethoscope over the brachial artery. 15. Inflate the cuff. 16. Loosen valve and deflate the cuff slowly noting the systolic and diastolic reading. 17. Deflate the cuff completely and remove from the resident s arm. 18. Record blood pressure on paper. *19. Recorded reading must be within 4 mm systolic and 4 mm diastolic of that obtained by the evaluator. 20. Wash your hands and record and report observations to the nurse. 31

32 RESIDENT POSITIONING AND ALIGNMENT FOWLER S (This procedure begins in supine position) 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise the head of the bed to a degree angle. 3. Keep the spine straight. 4. Support the head with a pillow. 5. Support the arms with pillows. *6. Attach signal light within the resident s reach. 7. Wash hands and report & record observations. 32

33 RESIDENT POSITIONING AND ALIGNMENT LATERAL / SIDE (This procedure begins in supine position) 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise bed rails. Raise the bed to best level for good body mechanics. 3. Lower rail on side where you are working. 4. Place a pillow under the resident s head and neck. 5. Roll resident to side away from you. 6. Place the upper leg in front of the lower leg. 7. Support the upper leg and thigh with pillows. 8. Place a pillow against the resident s back. 9. Place a small pillow under the upper hand and arm. *10. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 11. Wash hands and report & record observations. 33

34 RESIDENT POSITIONING AND ALIGNMENT SUPINE (This procedure begins in lateral position) 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise bed rails. Raise the bed to best level for good body mechanics. 3. Lower rail on side where you are working. 4. Place a pillow under the resident s head and shoulders. 5. Roll resident into supine position. 6. Position arms comfortably at each side. *7. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 8. Wash hands and report & record observations. 34

35 PROVIDING MOUTH CARE THE UNCONSCIOUS RESIDENT 1. Knock before entering the room. Identify and greet resident. Explain procedure. Wash your hands. Provide for privacy. *2. Raise bed rails. Raise the bed to best level for good body mechanics. 3. Lower the bed rail nearest you. *4. Put on disposable gloves. Position the resident in the side lying position, facing you. Turn resident s head well to the side. 5. Place the towel under the resident s face. Place kidney/emesis basin under the chin. 6. Clean the chewing and inner surfaces of the teeth using appropriate supplies. 7. Swab the roof of the mouth, inside of the cheeks, and the lips using appropriate supplies. 8. Swab the tongue using appropriate supplies. 9. Moisten a clean sponge swab with water, and swab the mouth to rinse. 10. Apply moisturizer to the resident s lips. 11. Remove and discard the gloves. 12. Reposition the resident. *13. Raise side rail. Lower bed. Lower side rail. Attach signal light within resident s reach. 14. Wash hands and report & record observations. 35